Introduction

Solitary rectal ulcer syndrome (SRUS) is a chronic benign disorder characterized by the presence of an abnormality of the rectum in persons who have a long history of straining during defecation. It is a misnomer as only 3^rd of the patients have solitary ulcer, many have no ulcer.

Aims & Methods

This was a retrospective observational longitudinal study, conducted in the department of Gastroenterology at Jinnah Post graduate Medical Center and National Medical Center, Karachi, from 1^st March 2017 to till to date . All adult patients of either gender diagnosed with SRUS on basis of clinical history and endoscopic features were included in the study. The data obtained was analyzed on the statistical software SPSS version 26.Descriptive statistics were obtained by frequencies and percentages.

Results

There were total 85 patients in our study out of which 49(58%) were female and 36(42%) were male. Mean age was 35 ±17 years. Most common presentation was per rectal bleed 68(80%) ,Constipation 58 (68.57%) and followed by abdominal pain 32(37.9%).The most common predisposing risk factor was 85 (100%) self-digitation, 51(60%) prolong stay in toilet and rectal prolapse 5 (7.1%). Endoscopically most common finding was of single ulcer 80(95.7%), followed by proctitis 59(70%) and multiple ulcers 12(14.3%) and Histology revealed mucosal ulceration 75(88%) extension of muscular fibers 65 (77%), fibromuscular obliteration of lamina propria 59(70%) and crypt distortion 54 (64.3%). Associated psychological condition among patients were obsessive compulsive disorder 51 (60%) and anxiety disorder 46(52%). Most of the patients were treated through lifestyle modification and biofeedback. Only 4 patients were referred to surgical intervention.

Conclusion

SRUS is a rare disorder with variable clinical presentation. In this study patients commonly presented with bleeding p/r followed by abdominal pain. However, common predisposing factor was self -digitation, in this regard awareness is needed in our region.

References

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3. Thirumal P, Sumathi B, Nirmala D. A Clinical entity often missed-solitary rectal ulcer syndrome in children. Front Pediatr. 2020;8:396.
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5. Abusharifah O, Bokhary RY, Mosli MH, Saadah OI. Solitary rectal ulcer syndrome in children and adolescents: a descriptive clinicopathologic study. Int J Clin Exp Pathol. 2021;14(4):399-407.
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Introduction

The cornerstone of acute cholangitis treatment is antibiotic therapy combined with biliary drainage. The Tokyo Guidelines 2018 provide severity grading criteria that help predict prognosis and identify patients requiring early biliary drainage. While mild cholangitis can often be managed initially with antibiotics alone, moderate and severe cases typically require early and emergent drainage, respectively. Our aim is to explore factors influencing the timing of ERCP in acute cholangitis and its impact on clinical outcomes.

Aims & Methods

This retrospective single-center cohort study included patients diagnosed with acute cholangitis who underwent ERCP between March 2022 and March 2023 in a tertiary hospital with ERCP. Diagnosis and severity grading were based on the Tokyo Guidelines 2018. Descriptive and statistical analyses were performed to evaluate patient characteristics, severity classification, timing to ERCP and related clinical outcomes.

Results

A total of 104 patients underwent ERCP for acute cholangitis; 55 were female (52.9%) and the median age was 77 years. Based on the Tokyo 2018 criteria, 28 patients (26.9%) had grade III cholangitis, 52 (50%) grade II and 24 (23%) grade I. Only 5 patients (4.8%) underwent ERCP within 24 hours of admission—2 with grade III, 1 with grade II and 2 with grade I. Within 72 hours, 31 patients (29.8%) had undergone ERCP—9 with grade III, 16 with grade II and 6 with grade I. Notably, 70.8% of grade III cases were submitted to ERCP more than 72 hours after admission, with a median of 3 days of antibiotics before the procedure. There was no statistically significant association between ERCP timing and patient age, cholangitis severity, intensive/intermediate care admission or anticoagulant/antiplatelet use. However, admission on a Friday or Saturday was significantly associated with delayed ERCP (p=0.007), with 91% of these patients undergoing ERCP after 72 hours, compared to 56% for admissions on other days. Cholangitis severity correlated significantly with total hospital stay (grade I: 7 ± 3 days, grade II: 8 ± 3.8 days, grade III: 10.5 ± 9 days; p=0.001). ERCP timing was also associated with total antibiotic duration (<24h: 9 ± 2.6 days, 24–72h: 8 ± 3 days, >72h: 10 ± 4.8 days; p=0.043). The 30-day mortality rate was 4.8%, with no significant association with ERCP timing or severity grade.

Conclusion

In this real-world cohort, ERCP was frequently delayed beyond the recommended window, even in severe acute cholangitis. Weekend admission was a significant contributor to this delay. However, no association was found between ERCP timing and 30-day mortality, likely due to small sample size. These findings highlight the need for optimized access to biliary drainage, particularly during weekends, to better meet guideline recommendations.